CORNEAL ENDOTHELIUM 5 YEARS AFTER TRANSPLANTATION
CORNEAL ENDOTHELIUM 5 YEARS AFTER TRANSPLANTATION
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DOI：
10.1016/s0002-9394(14)72898-3
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发表时间：
1994-08-01
影响因子：
4.2
通讯作者：
NELSON, LR
中科院分区：
文献类型：
--
作者：
BOURNE, WM;HODGE, DO;NELSON, LR
我们要求500例连续角膜移植的受者在术后两个月、一年、三年和五年时返回进行检查和内皮照相。排除双侧病例中的36例再植眼和70例对侧眼，保留394眼进行分析。我们还记录了移植物排斥和失败的事件。在129例在每次术后间隔返回并且没有排斥反应发作的患者中，角膜移植术后3年至5年，平均内皮细胞密度继续每年下降7.8%，而在未手术的正常角膜中，平均内皮细胞密度每年下降约0.5%。角膜移植术后5年，与术前检查相比，平均细胞丢失率为58.9%。角膜移植术后5年，六角形细胞的百分比没有恢复到术前水平，这表明内皮细胞仍然不稳定。平均角膜厚度随时间显著增加。角膜移植术后5年，Kaplan-Meier法的排斥反应发生率和失败率分别为19%和17%。角膜移植术后5年，植入后房型透镜的眼睛比植入开放环形前房型透镜的眼睛失去更多的内皮细胞。低内皮细胞密度与角膜厚度增加和随后失败的风险增加有统计学显著相关。角膜移植术后5年成功的角膜移植的中央内皮细胞形成不稳定的单层，细胞持续加速丢失，细胞形态特征异常。这一过程导致较少的内皮细胞保留在中央移植物上，伴随基质肿胀和移植物衰竭的相关增加。
We asked the recipients of 500 consecutive corneal transplants to return for examination and endothelial photography at two months and at one, three, and five years postoperatively. Thirty-six regrafts and 70 fellow eyes of bilateral cases were excluded, leaving 394 eyes for analysis. We also recorded episodes of graft rejection and failure. In 129 grafts in patients who returned at each postoperative interval and had no rejection episodes, the mean endothelial cell density continued to decrease 7.8% per year from three years to five years after keratoplasty, compared with approximately 0.5% per year in unoperated-on normal corneas. The mean cell loss compared with the preoperative examination was 58.9% five years after keratoplasty. The percentage of hexagonal cells did not return to preoperative levels by five years after keratoplasty, suggesting that the endothelium continued to be unstable. The mean corneal thickness increased significantly with time. The Kaplan-Meier rates of rejection episodes and failure were 19% and 17%, respectively, five years after keratoplasty. Eyes with posterior chamber lens implants lost more endothelial cells by five years after keratoplasty than did eyes with open-looped anterior chamber lens implants. Low endothelial cell densities were statistically significantly associated with increased corneal thickness and with an increased risk of subsequent failure. The Central endothelial cells of successful corneal transplants five years after keratoplasty form an unstable monolayer with continued accelerated loss of cells and abnormal cellular morphologic features. This process results in fewer endothelial cells remaining on the central graft with an associated increase in stromal swelling and graft failure.